Feasibility, acceptability, and appropriateness of screening and referring for social risks in a community hospital setting

Objectives: In response to AAP and CMS recommendations, a growing number of hospitals are implementing inpatient social care systems, but nearly all pediatric studies to date have been conducted in children's hospitals. In 2022, a university-affiliated community hospital implemented a pediatric inpatient social risk screening and referral system. We aimed to assess the feasibility, acceptability, and appropriateness of this system in the community hospital setting.

Methods: We used a concurrent mixed methods approach from March-December 2023, surveying parents of hospitalized children and clinicians who perform or respond to screening, to assess implementation outcomes-feasibility, acceptability, and appropriateness-using validated measures based on 5-point Likert scales. We concurrently performed semi-structured interviews assessing clinician and parent experiences with implementation and performed a thematic analysis.

Results: Forty-three parents (67%) and 31 clinicians (78%) completed surveys, and 20 interviews (11 parents, nine clinicians) were performed. Among parents and clinicians, respectively, 95% and 97% rated implementation as feasible, 97% and 93% as acceptable, and 95% and 97% as appropriate. Interview themes emerged regarding feasibility: (i) community/hospital resources enable social care, (ii) challenging limitations in social service personnel; acceptability: (i) value added to inpatient care, (ii) positive impact on families' health, (iii) inadequate expectation-setting concerns; and appropriateness: (i) natural fit within workflows, (ii) desire for different modality/timing options.

Conclusions: Implementation of a pediatric inpatient social care system was feasible, acceptable and appropriate in a community hospital setting; however, challenges and key areas for improvement were identified that can serve as leverage points for future implementation strategies.